Fillable Printable Form I-508

Form I-508

Request for Waiver of Certain Rights, Privileges,

Exemptions, and Immunities

Department of Homeland Security

U.S. Citizenship and Immigration Services

USCIS

Form I-508

OMB No. 1615-0025

Expires 05/31/2019

START HERE - Please type or print in black ink.►

Alien Registration Number (A-Number) (if any)

5.U.S. State Department-Issued Personal Identification Number (PID)

Country

Ste.NumberFlr.Apt.

In Care Of Name

ProvincePostal Code

ZIP CodeState

City or Town

Mailing Address6.

4.U.S. Social Security Number (if any)3.Date of Birth (mm/dd/yyyy)

►A-

Part 1. Information About the Person Filing This Request

►

Form I-508F

executed

Exempt from U.S. taxes

Not exempt from U.S. taxes

For Government

Use Only

Given Name (First Name) Family Name (Last Name) Middle Name

8.Physical Address

Is your current mailing address the same as your physical address?

If you answered "No," provide your physical address in Item Number 8.

7.YesNo

Employment Information9.

Name of Mission or Organization

Country

Ste.NumberFlr.Apt.Street Number and Name

ProvincePostal Code

ZIP CodeState

City or Town

Country

Ste.NumberFlr.Apt.Street Number and Name

ProvincePostal Code

ZIP CodeState

City or Town

Street Number and Name

Requestor is a French

national paid by the

French Republic

Remarks

Form I-508 05/26/17 NPage 1 of 5

Part 3. Requestor's Statement, Contact Information, Certification, and Signature

NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the boxfor Item Number 2.

Requestor's Statement Regarding the Interpreter

Requestor's Statement Regarding the Preparer

I have requested the services of and consented to,

who

is not an attorney or accredited representative, preparing this request for me.

I, , believe that I have an

occupational status entitling me to nonimmigrant status under section 101(a)(15)(A), (E), or (G) of the Immigration and Nationality

Act (INA) as a government official, treaty trader or treaty investor, or international organization representative, respectively.

Part 2. Waiver Statement

Accordingly, as I seek to acquire or retain lawful permanent resident status, I hereby waive all diplomatic rights, privileges, exemptions,

and immunities that would otherwise accrue to me under any U.S. law or executive order because of my occupational status.

NOTE: French nationals receiving a salary from the French Republic are also required to complete Form I-508F. French nationals

must submit both Form I-508 and Form I-508F together to U.S. Citizenship and Immigration Services (USCIS).

I can read and understand English, and have read and understand every question and instruction on this request, as well

as my answer to every question.

to every question, in

The interpreter named in Part 4. has also read to me every question and instruction on this request, as well as my answer

, a language in which I am fluent.

I understand every question and instruction on this request as translated to me by my interpreter, and have provided

complete, true, and correct responses in the language indicated above.

Requestor's Certification

Requestor's Signature

Requestor's SignatureDate of Signature (mm/dd/yyyy) 6.

I certify, under penalty of perjury, that the information in my request and any document submitted with my request were provided by

me and are complete, true, and correct.

I furthermore authorize release of information contained in this request, in supporting documents, and in my USCIS records to other

entities and persons where necessary for the administration and enforcement of U.S. immigration laws.

Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS may

require that I submit original documents to USCIS at a later date. Furthermore, I authorize the release of any information from any

and all of my records that USCIS may need to determine my eligibility for the immigration benefit that I seek.

Requestor's Daytime Telephone NumberRequestor's Mobile Telephone Number (if any)

Requestor's Email Address (if any)

3.4.

Requestor's Contact Information

Form I-508 05/26/17 NPage 2 of 5

Interpreter's Mailing Address

Part 4. Interpreter's Contact Information, Certification, and Signature

Interpreter's Given Name (First Name)Interpreter's Family Name (Last Name)1.

Interpreter's Full Name

Interpreter's Business or Organization Name (if any)2.

Provide the following information concerning the interpreter.

Date of Signature (mm/dd/yyyy) Interpreter's Signature

The requestor has informed me that he or she understands every instruction and question on the request, as well as the answer to every

question, and the requestor verified the accuracy of every answer.

Interpreter's Certification

I certify that:

I am fluent in English and

, which is the same language provided

I have read to this requestor every question and instruction on this request, as well as the answer to every question, in the language

provided in Part 3., Item B. in Item Number 1.; and

in Part 3., Item B. in Item Number 1.;

Interpreter's Signature

Interpreter's Contact Information

Interpreter's Daytime Telephone Number

Interpreter's Email Address (if any)4.5.

Country

Ste.NumberFlr.Apt.Street Number and Name

ProvincePostal Code

ZIP CodeState

City or Town

Form I-508 05/26/17 NPage 3 of 5

Preparer's Mailing Address

Part 5. Contact Information, Statement, Certification, and Signature of the Person Preparing this

Request, If Other Than the Requestor

Preparer's Full Name

Preparer's Given Name (First Name)

Preparer's Family Name (Last Name)1.

Preparer's Business or Organization Name (if any)2.

Provide the following information concerning the preparer.

Preparer's Contact Information

Preparer's Daytime Telephone Number Preparer's Fax Number

Preparer's Email Address (if any)

Preparer's Statement

Preparer's Signature Date of Signature (mm/dd/yyyy)

Preparer's Certification

Preparer's Signature

By my signature, I certify, swear, or affirm, under penalty of perjury, that I prepared this request on behalf of, at the request of, and

with the express consent of the requestor. I completed this request based only on responses the requestor provided to me. After

completing the request, I reviewed it and all of the requestor's responses with the requestor, who agreed with every answer on the

request. If the requestor supplied additional information concerning a question on the request, I recorded it on the request.

I am an attorney or accredited representative and my representation of the requestor in this case

extends does not extend beyond the preparation of this request.

I am not an attorney or accredited representative but have prepared this request on behalf of the requestor and with the

requestor's consent.

NOTE: If you are an attorney or accredited representative whose representation extends beyond preparation of this

request, you must submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited

Representative, with this request.

Country

Ste.NumberFlr.Apt.Street Number and Name

ProvincePostal Code

ZIP CodeState

City or Town

Form I-508 05/26/17 NPage 4 of 5

Part 6. Additional Information

If you need extra space to provide any additional information within this request, use the space below. If you need more space than

what is provided, you may make copies of this page to complete and file with this request or attach a separate sheet of paper. Include

your name and A-Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which

your answer refers; and sign and date each sheet.

A-Number (if any)►

A-

Page Number

Part NumberItem Number

Family Name (Last Name)Given Name (First Name)Middle Name

B.C.

Page Number

Part Number

Item Number4.B.C.

Page Number

Part NumberItem Number

5.B.C.

Page Number

Part NumberItem Number

6.B.C.

Form I-508 05/26/17 NPage 5 of 5